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01/14/2006

Response on Whether Organs Should be Purchased and Sold-BECKER

Sorry for this delay in responding about organ markets, but I have been tied up with other matters. On the whole the comments led to a very sophisticated discussion, with a minimal number of personal attacks. Let me respond briefly.
Barter arrangements like LifeSharers may well improve the present transplant system, but they have all the disadvantages of barter. That is why money and markets have replaced barter throughout the world.
I indicated that opt out systems do not have a large effect on organ donations. The reason is mainly that family members often overrule the implied wishes of their deceased relatives. I suspect that many people do not take the effort to opt out because they expect their parents or children to have the ultimate say.
A common concern among the critics is that the poor will both give too many of their organs, and not have access to transplants. I have more confidence than these critics do in the ability of the vast majority of poor people to make decisions in their self-interest. Moreover, market forces rather than rich persons would determine the price of organs, in the same way that rich people do not presently set the price of maid services.
Most organ transplants are paid by private insurance, Medicaid, or Medicare. Since that would continue, and since I indicated that market-determined organ prices are unlikely to add much to the total cost of transplants, the poor should not be at more of a disadvantage in getting transplants if organs were sold than they are under the present system. Indeed, they are likely to be at less of a disadvantage when the supply of organs clears the demand for organs. For the rich and famous sometimes can now use influence to get priority, and they can travel to countries where they are assured of getting a transplant.
Someone argued for a tax on people who do not agree to make their organs available rather than a price clearing market in organs. Taxing is an alternative way to clear the organ market, and also the markets for steel, apples, and other products as well. The rich would have far more influence over the setting of the magnitude and form of these taxes than they would in the determination of organ prices that raise supply to equal demand. Minimizing the use of force and other government powers in determining supply is a general advantage of market determination of prices that fully applies to organs.
At least one of you claimed that the price of organs would be high because of the so-called "endowment" affect, while others thought it would be too "low" because the poor would be duped. It cannot be both, and I believe it would be neither, partly for the reasons in the post and above.
Many decisions in life have important elements of irreversibility in the sense that the cost of reversing may be either infinite or very large. These include going to law school, marrying a particular person, joining the armed forces for several years, etc. The irreversibility of organ donation for a live transplant will make people consider that issue carefully. The present system is in this regard worst since often family members are pressured into making quick decisions about providing organs for live transplants because their relatives would die if they did not get a transplant, and they cannot expect an organ soon, given their place on the queue.
I have been at several international conferences of transplant surgeons, and have argued there for markets in organs. While I believe most but far from all of these surgeons oppose such a change, they all recognize the very serious problems with the present system. Surgeons and hospitals fight sometimes over who has access to available organs, they see many patients die because they cannot get organs, and they often must perform a transplant surgery at a time that is not optimal for a person receiving the transplant because a matching organ becomes available at a particular moment.
So I believe much more of the concern expressed in some comments should relate to persons in need of transplants who either die because they cannot get them, or wait for years in ill-health before they receive suitable organs.

Comments

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Professor Becker said "Barter arrangements like LifeSharers may well improve the present transplant system, but they have all the disadvantages of barter. That is why money and markets have replaced barter throughout the world."

This is certainly true. But barter makes a lot of sense in this case, because a monetary market for organs is illegal and there is little or no chance of that changing in the forseeable future.

Participating in LifeSharers is rational, unless you are sure you'll never need a transplant. You give up your organs after you can't use them any more. In return, you increase your chances of getting a transplant if you ever need one. This is an excellent trade, given that more than half of the people who need transplants in the United States will die before they get one. You can join LifeSharers for free at www.lifesharers.org.

Professor Becker also says "I believe much more of the concern expressed in some comments should relate to persons in need of transplants who either die because they cannot get them, or wait for years in ill-health before they receive suitable organs."

This really is the heart of the matter. What concerns are so important that we should forbid a father from buying an organ that would save his daughter's life? Please read Lloyd Cohen's "Directions for the Disposition of My (and Your) Vital Organs" at http://www.catoinstitute.org/pubs/regulation/regv28n3/v28n3-1.pdf.

In regards to the idea of taxing persons who choose not to donate organs. There are people who do not donate organs for religious reasons (Orthodox Jews, members of various Christian sects, etc.) A tax might be seen as a tax on those religions and I doubt the courts would allow it.

Even if there is a benefit from preventing poor people making bad decisions to sell their organs, it is disingenuous of you to ignore the costs of preventing their sale, which is that people die. Is it your contention that poor people are so stupid as to make it worth letting the sick die so as to protect the poor from their own bad decisions? Be serious.

In a healthy forest, majestic old trees die - and in so doing, allow younger trees to grow up and replace them. Note the opportunity for the best young trees to outcompete those of inferior stock (or luck of placement) and dominate the next generation.

Then you pull out the social Darwinism. Again. I don't know why you don't get slammed more often for writing this sort of thing. It's just wrongheaded. The whole issue of organs shortage and favoring the young etc disappears in a market which is allowed to clear. Nobody has to go without in a cleared market, so young and old alike can obtain transplants with the greater supply that markets provide. Markets mean nobody has to play god by picking who wins, which good when there are people with your values around.

Hypothetically (I'm not sure I support the idea), as a compromise solution that might be more politically palatable, rather than allowing the wholesale sale of organs by living people, what about simply allowing people pre-sell "rights" to their organs in case of their untimely (non-suicidal) deaths. This would increase the number of people willing to sign-off on the organ donor cards/driver's license boxes, etc., but still permit the flexibility to adhere to one's religious values. One could perceive this as a sort of bonus insurance policy (no doubt, the insurance industry would lobby against this) whereby people who suffer untimely deaths are able to pay for all or significant portions of their death expenses or even provide something extra for their families. Of course, you regulate this in cases of suicide (like regular insurance, there would be no payout), and one might ago further and allow living organ sales in highly regulated environments (to prevent the "duping" effects) with review boards, limits on total donations (perhaps one). Sure, these would add significant regulation-costs to the price of organs, but there are many less-significant markets where regulation costs are considered essential.

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